Myo-Inositol for PCOS and Hashimotos

My previous article covered the beneficial effect of selenium in Hashimoto’s patients, with a decline in antibody levels seen in four controlled studies in the endocrinology literature. Here is another one. This time the selenium is used with an added supplement called Myo-Inositol, a substance known to be involved in cell signalling. The Myo-Inositol makes the TSH receptors more sensitive to the TSH signal which is useful in euthyroid Hashimoto’s patients.(1) In a 2013 study from Rome, just published in the Journal of Thyroid Research, patients taking the selenium – myo-inositol combination had a reduction in TSH while those taking selenium alone had no change in TSH. In both groups the antibodies declined significantly.(1)

Myo-Inositol is also effective for panic disorder. A small study published in 2001 showed it was more effective than SSRI antidepressants.(3) Large doses, up to 16 grams per day, were used. (3) It may also be effective for Depression and OCD (obsessive compulsive disorder).(2-4),(11-13)

PCOS-PolyCystic Ovary Syndrome

Myo-inositol is very effective in PCOS (polycystic ovary syndrome, restoring insulin sensitivity, reducing acne and hirsutism, and restoring normal cycling and fertility in many patients. (5-10)

1) http://www.hindawi.com/journals/jtr/2013/424163/http://www.ncbi.nlm.nih.gov/pubmed/24224112
J Thyroid Res. 2013;2013:424163. Epub 2013 Oct 2.
Combined treatment with Myo-inositol and selenium ensures euthyroidism in subclinical hypothyroidism patients with autoimmune thyroiditis. Nordio M, Pajalich R.
Background. Hashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis or chronic autoimmune thyroiditis, is the most common form of thyroiditis affecting more than 10% of females and 2% of males. The present study aims to evaluate the beneficial effect of a combined treatment, Myo-Inositol plus selenomethionine, on subclinical hypothyroidism. Methods. The study was designed as a double-blind randomized controlled trial. Eligible patients were women diagnosed with subclinical hypothyroidism having Tg antibodies (TgAb) titer higher than 350 IU/mL. Outcome measures were Thyroid Stimulating Hormone (TSH) levels, thyroid peroxidase antibodies (TPOAb) and TgAb titer, selenium, and Myo-Inositol plasma concentration. Results. In the present paper, we demonstrated that the beneficial effects obtained by selenomethionine treatment on patients affected by subclinical hypothyroidism, likely due to the presence of autoantibody (TPOAb and TgAb), are further improved by cotreatment with Myo-Inositol. Conclusions. Indeed, due to its action as TSH second messenger, Myo-Inositol treatment reduces TSH levels closer to physiological concentrations.

Patients were randomized into 2 groups according to their initial TPOAb concentrations. group A consisted of 24 patients who received orally 83 g selenomethionine/day, in a soft gel capsule; group B consisted of 24 patients who received a combined treatment plus Myo-Inositol 600 mg also in a 83 g selenomethionine, soft gel capsule, orally, for 6 months.The patients were asked to take the medication with water about 2 h before or after a meal. They were not given further treatment, such as over-the-counter vitamins or trace elements.

TSH concentrations significantly decreased in group B by 31% (4.4 ± 0.9 versus 3.1 ± 0.6 mIU/mL, ). On the other hand, there was no change in the TSH level in the group A.

Eleven patients in the combined treated group showed a reduction of the TgAb below the threshold identified as inclusion criterion, compared to three patients in group A. Ultrasound of the thyroid showed normalized echogenicity in these patients.

Myo-inositol may aid in the treatment of panic disorder, according to a small study published in the Journal of Clinical Psychopharmacology in 2001. For the study, 20 patients with panic disorder underwent one month of treatment with 18 g of myo-inositol per day, followed by one month of treatment with 150 mg of fluvoxamine (a medication commonly prescribed for psychiatric disorders) per day. Study results showed that inositol reduced the number of panic attacks per week by four (compared with a reduction of 2.4 with fluvoxamine).

3) http://www.ncbi.nlm.nih.gov/pubmed/11386498
J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder.
Palatnik A, Frolov K, Fux M, Benjamin J.
Only 70% of patients respond to current treatments for panic disorder, and many discontinue drugs because of side effects. myo-Inositol, a natural isomer of glucose and a precursor for the second-messenger phosphatidyl-inositol system, has previously been found superior to placebo in the treatment of depression, panic disorder, and obsessive-compulsive disorder (OCD), but a direct comparison with an established drug has never been performed. A double-blind, controlled, random-order crossover study was undertaken to compare the effect of inositol with that of fluvoxamine in panic disorder. Twenty patients completed 1 month of inositol up to 18 g/day and 1 month of fluvoxamine up to 150 mg/day. Improvements on Hamilton Rating Scale for Anxiety scores, agoraphobia scores, and Clinical Global Impressions Scale scores were similar for both treatments. In the first month, inositol reduced the number of panic attacks per week (mean and SD) by 4.0 (2) compared with a reduction of 2.4 (2) with fluvoxamine (p = 0.049). Nausea and tiredness were more common with fluvoxamine (p = 0.02 and p = 0.01, respectively). Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. Continuing reports of inositol’s efficacy in the treatment of depression, panic disorder, and OCD should stimulate replication studies.

7)http://www.ncbi.nlm.nih.gov/pubmed/22296306
Gynecol Endocrinol. 2012 Jul;28(7):509-15. doi: 10.3109/09513590.2011.650660. Epub 2012 Feb 1.
Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials.
Unfer V, Carlomagno G, Dante G, Facchinetti F.
Polycystic ovary syndrome (PCOS) affects 5%-10% of women in reproductive age, and it is the most common cause of infertility due to ovarian dysfunction and menstrual irregularity. Several studies have reported that insulin resistance is common in PCOS women, regardless of the body mass index. The importance of insulin resistance in PCOS is also suggested by the fact that insulin-sensitizing compounds have been proposed as putative treatments to solve the hyperinsulinemia-induced dysfunction of ovarian response to endogenous gonadotropins. Rescuing the ovarian response to endogenous gonadotropins reduces hyperandrogenemia and re-establishes menstrual cyclicity and ovulation, increasing the chance of a spontaneous pregnancy. Among the insulin-sensitizing compounds, there is myo-inosiol (MYO). Previous studies have demonstrated that MYO is capable of restoring spontaneous ovarian activity, and consequently fertility, in most patients with PCOS. With the present review, we aim to provide an overview on the clinical outcomes of the MYO use as a treatment to improve ovarian function and metabolic and hormonal parameters in women with PCOS.

8) http://www.ncbi.nlm.nih.gov/pubmed/22612517
Gynecol Endocrinol. 2012 Dec;28(12):969-73. Epub 2012 May 21. Differential insulin response to myo-inositol administration in obese polycystic ovary syndrome patients.
Genazzani AD, Prati A, Santagni S, Ricchieri F, Chierchia E, Rattighieri E, Campedelli A, Simoncini T, Artini PG.
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, chronic anovulation, polycystic ovaries at ultrasound evaluation, and quite frequently by insulin resistance or compensatory hyperinsulinemia. Attention has been given to the role of inositol-phosphoglycan (IPG) mediators of insulin action and growing evidences suggest that a deficiency of D-chiro-inositol (DCI) containing IPG might be at the basis of insulin resistance, frequent in PCOS patients. On such basis, we investigated the efficacy on insulin sensitivity and hormonal parameters of 8 weeks treatment with myo-inositol (MYO) (Inofert, ItalPharmaco, Milano, Italy) at the dosage of 2 g day in a group (n = 42) of obese PCOS patients,. After the treatment interval body mass index (BMI) and insulin resistance decreased together with luteinizing hormone (LH), LH/FSH and insulin. When subdividing the patients according to their fasting insulin levels, Group A (n = 15) insulin below 12 µU/ml and Group B (n = 27) insulin above 12 µU/ml, MYO treatment induced similar changes in both groups but only patients of Group B showed the significant decrease of both fasting insulin plasma levels (from 20.3 ± 1.8 to 12.9 ± 1.8 µU/ml, p < 0.00001) and of area under the curve (AUC) of insulin under oral glucose tolerance test (OGTT). In conclusion, our study supports the hypothesis that MYO administration is more effective in obese patients with high fasting insulin plasma levels.

9) http://www.ncbi.nlm.nih.gov/pubmed/19551544
Gynecol Endocrinol. 2009 Aug;25(8):508-13.
Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Zacchè MM, Caputo L, Filippis S, Zacchè G, Dindelli M, Ferrari A.
Polycystic ovary syndrome (PCOS) is the most common endocrine cause of hirsutism, acne and pattern alopecia, often characterised by ovulation disorders (usually manifested as oligo- or amenorrhea). In addition, 30-40% of women with PCOS have impaired glucose tolerance, and a defect in the insulin signalling pathway seems to be implicated in the pathogenesis of insulin resistance. For this reason, insulin-lowering medications represent novel approach in women with PCOS. The aim of this study was to evaluate the effects of myo-inositol (MYO), an isoform of inositol, belonging to the vitamin B complex, in the treatment of cutaneous disorders like hirsutism and acne.
METHODS: Fifty patients with PCOS were enrolled in the study. BMI, LH, FSH, insulin, HOMA index, androstenedione, testosterone, free testosterone, hirsutism and acne were evaluated at the baseline and after receiving MYO therapy for 6 months.
RESULTS: After 3 months of MYO administration, plasma LH, testosterone, free testosterone, insulin and HOMA index resulted significantly reduced; no significant changes were observed in plasma FSH and androstenedione levels. Both hirsutism and acne decreased after 6 months of therapy.
DISCUSSION: MYO administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne.

Polycystic ovary syndrome (PCOS) is often characterized by chronic oligo- or anovulation (usually manifested as oligo- or amenorrhea), and hyperandrogenism. In addition, 30-40% of PCOS women have impaired glucose tolerance, and a defect in the insulin signaling pathway (inositol-containing phosphoglycan mediators) seems to be implicated in the pathogenesis of insulin resistance. PCOS patients are subfertile as a consequence of such ovulatory disorders and often need drugs, such as clomiphene citrate or follicle-stimulating hormone, for ovulation induction, which increases the risk of multiple pregnancy and ovarian hyperstimulation syndrome. We hypothesized that the administration of an isoform of inositol (myo-inositol), belonging to the vitamin B complex, would improve the insulin-receptor activity, restoring normal ovulatory function.
MATERIALS AND METHODS:Twenty-five PCOS women of childbearing age with oligo- or amenorrhea were enrolled in the study. Ovulatory disorder due to PCOS was apparently the only cause of infertility; no tubal defect or deficiency of male semen parameters was found. Myo-inositol combined with folic acid (Inofolic) 2 g twice a day was administered continuously. During an observation period of 6 months, ovulatory activity was monitored with ultrasound scan and hormonal profile, and the numbers of spontaneous menstrual cycles and eventually pregnancies were assessed.
RESULTS:Twenty-two out of the 25 (88%) patients restored at least one spontaneous menstrual cycle during treatment, of whom 18 (72%) maintained normal ovulatory activity during the follow-up period. A total of 10 singleton pregnancies (40% of patients) were obtained. Nine clinical pregnancies were assessed with fetal heart beat at ultrasound scan. Two pregnancies evolved in spontaneous abortion.
CONCLUSION:Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS. This therapy did not cause multiple pregnancy.———–

11) http://www.ncbi.nlm.nih.gov/pubmed/7793450
Am J Psychiatry. 1995 Jul;152(7):1084-6.
Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder.
Benjamin J, Levine J, Fux M, Aviv A, Levy D, Belmaker RH.
Because they found in an earlier study that inositol, an important intracellular second-messenger precursor, was effective against depression in open and double-blind trials, the authors studied its effectiveness against panic disorder.
METHOD:Twenty-one patients with panic disorder with or without agoraphobia completed a double-blind, placebo-controlled, 4-week, random-assignment crossover treatment trial of 12 g/day of inositol.
RESULTS:The frequency and severity of panic attacks and the severity of agoraphobia declined significantly more after inositol than after placebo administration. Side effects were minimal.
CONCLUSIONS:The authors conclude that inositol’s efficacy, the absence of significant side effects, and the fact that inositol is a natural component of the human diet make it a potentially attractive therapeutic for panic disorder.

13) http://www.ncbi.nlm.nih.gov/pubmed/9169302
Eur Neuropsychopharmacol. 1997 May;7(2):147-55.
Controlled trials of inositol in psychiatry.
Levine J.
Inositol is a simple polyol precursor in a second messenger system important in the brain. Cerebrospinal fluid inositol has been reported as decreased in depression. A double-blind controlled trial of 12 g daily of inositol in 28 depressed patients for four weeks was performed. Significant overall benefit for inositol compared to placebo was found at week 4 on the Hamilton Depression Scale. No changes were noted in hematology, kidney or liver function. Since many antidepressants are effective in panic disorder, twenty-one patients with panic disorder with or without agoraphobia completed a double-blind, placebo-controlled, four week, random-assignment crossover treatment trial of inositol 12 g per day. Frequency and severity of panic attacks and severity of agoraphobia declined significantly with inositol compared to placebo. Side-effects were minimal. Since serotonin re-uptake inhibitors benefit obsessive compulsive disorder (OCD) and inositol is reported to reverse desensitization of serotonin receptors, thirteen patients with OCD completed a double-blind controlled crossover trial of 18 g inositol or placebo for six weeks each. Inositol significantly reduced scores of OCD symptoms compared with placebo. A controlled double-blind crossover trial of 12 g daily of inositol for a month in twelve anergic schizophrenic patients, did not show any beneficial effects. A double-blind controlled crossover trial of 6 g of inositol daily vs. glucose for one month each was carried out in eleven Alzheimer patients, with on clearly significant therapeutic effects. Antidepressant drugs have been reported to improve attention deficit disorder (ADDH) with hyperactivity symptomatology. We studied oral inositol in children with ADDH in a double-blind, crossover, placebo-controlled manner. Eleven children, mean age 8.9 +/- 3.6 years were enrolled in an eight week trial of inositol or placebo at a dose of 200 mg/kg body weight. Results show a trend for aggravation of the syndrome with myo-inositol as compared to placebo. Recent studies suggest that serotonin re-uptake inhibitors are helpful in at least some symptoms of autism. However a controlled double-blind crossover trial of inositol 200 mg/kg per day showed no benefit in nine children with autism. Cholinergic agonists have been reported to ameliorate electroconvulsive therapy (ECT)-induced memory impairment. Inositol metabolism is involved in the second messenger system for several muscarinic cholinergic receptors. Inositol 6 g daily was given in a crossover-double-blind manner for five days before the fifth or sixth ECT to a series of twelve patients, without effect. These results suggest that inositol has therapeutic effects in the spectrum of illness responsive to serotonin selective re-uptake inhibitors, including depression, panic and OCD, and is not beneficial in schizophrenia, Alzheimer’s ADDH, autism or ECT-induced cognitive impairment.

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Carol

Hi there. Very interesting post. Thank you.I just got some inositol. (I got IP6, which is inositol hexaphosphate. Not sure if that is the same as myo-inositol, but I’m guessing it is not.) I have both Hashimoto’s and insulin resistance. The bottle says not to take it near meds or daily minerals. I take meds multiple times a day and also take minerals, as I’m chelating. So, it’s very hard to find a significant amount of time to take it away from meds/supps. I absolutely understand you can’t give medical advice to someone you don’t know. I’m asking more generally if you know about this and agree. Are there any other contraindications for taking myo-inositol? Thanks much for your great site and for your time.